OPHTE# d"S33aa-2i Harnett County Department of Public Health 24099
PERMIT # Operation Permit
i� New Installation Septic Tank Nitrification Line El Repair F-1Expansion
PROPERTY LO[ATIO : G`� Jo4oN Zy
Name: (owner) �oy�soN �e ao 1` VV t4k(,SUBDIVISION LOT #
System Installer. s �T2,cKv�yp Registration #
Basement with plumbing: ❑ Garage k❑, Number of Bedrooms 3
Type of Water Supply: ❑ Community ey Public ❑ Well Distance from well I f:) 0 feet
System Type: � Types V and VI Systems expire in S years.
(In accordance with Table V a) Owner must contact Health Department 6 months prior to expiration for permit renewal.
PERMIT CONDITIONS:
I. Performance:
If. Monitoring
III. Maintenance:
IV. Operation:
V. Other:
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System shall perform in accordance with Rule .1961.
As required by Rule .1961.
As required by Rule .1961. Other.
Subsurface system operator required? Yes ❑ N
If yes, see attached sheet for additional operation a
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maintenance and reporting.
❑ D -Box ❑ Pump ❑ Alarm ❑ H201-ine ❑ PWR Line
Following are the specifications for the sewage disposal s stem on the above captioned property.
Type of system: El Conventional �y Other W'z Septic Tank: t 00 0 gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches 3 of each ditch l a- Q feet ditches 3 feet ditches inches
French Drain Required: Linear feet
Authorized State Agent ��n Date 71,01 1t.
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